OBJECTIVES: To determine the effects of low-to-moderate levels of maternal alcohol consumption in pregnancy on pregnancy and longer-term offspring outcomes.

SEARCH STRATEGY: Medline, Embase, Web of Science and Psych info from inception to 11 July 2016.

SELECTION CRITERIA: Prospective observational studies, negative control and quasi experimental studies of pregnant women estimating effects of light drinking in pregnancy (</=32 g/week) versus abstaining. Pregnancy outcomes such as birth weight and features of fetal alcohol syndrome were examined.

DATA COLLECTION AND ANALYSIS: One reviewer extracted data and another checked extracted data. Random effects meta-analyses were performed where applicable, and a narrative summary of findings was carried out otherwise.

MAIN RESULTS: 24 cohort and two quasi experimental studies were included. With the exception of birth size and gestational age, there was insufficient data to meta-analyse or make robust conclusions. Odds of small for gestational age (SGA) and preterm birth were higher for babies whose mothers consumed up to 32 g/week versus none, but estimates for preterm birth were also compatible with no association: summary OR 1.08, 95% CI (1.02 to 1.14), I2 0%, (seven studies, all estimates were adjusted) OR 1.10, 95% CI (0.95 to 1.28), I2 60%, (nine studies, includes one unadjusted estimates), respectively. The earliest time points of exposure were used in the analysis.

CONCLUSION: Evidence of the effects of drinking </=32 g/week in pregnancy is sparse. As there was some evidence that even light prenatal alcohol consumption is associated with being SGA and preterm delivery, guidance could advise abstention as a precautionary principle but should explain the paucity of evidence.

Published in Pregnant Women

AIM: To examine whether exposure to increased alcohol availability in utero is associated with later alcohol-related health problems.

METHOD: Register-linked population-based longitudinal study using data from a natural experiment setting, including 363 286 children born 1965-71. An experimental alcohol policy change was piloted in two regions of Sweden in 1967-68, where access to strong beer increased for 16-20 year old. Children exposed in utero to the policy change were compared to children born elsewhere in Sweden (excluding a border area), and to children born before and after the policy change. The outcome was obtained from the National Hospital Discharge Register using the Swedish index of alcohol-related inpatient care. Hazard ratios (HR) with 95% confidence intervals (CI) were estimated by Cox regression analysis.

RESULTS: The results suggest that children conceived by young mothers prior to the policy change but exposed to it in utero had a slightly increased risk of alcohol-related health problems later in life (HR 1.26, 95% CI 0.94-1.68). A tendency towards an inverse association was found among children conceived by older mothers (HR 0.88, 95% CI 0.74-1.06).

CONCLUSION: Results obtained from a natural experiment setting found no consistent evidence of long-term health consequences among children exposed in utero to an alcohol policy change. Some evidence however suggested an increased risk of alcohol-related health problems among the exposed children of young mothers.

Published in General Health

BACKGROUND: A strict high legal age limit for alcohol purchases decreases adolescents' access to alcohol, but little is known about long-term health effects. The aim was to estimate the effect of increased alcohol availability during adolescence on alcohol-related morbidity and mortality.

METHODS: A nationwide register-based study using data from a natural experiment setting. In two regions of Sweden, strong beer (4.5%-5.6% alcohol by volume) became temporarily available for purchase in grocery stores for individuals 16 years or older (instead of 21) in 1967/1968. The intervention group was defined as all individuals living in the intervention area when they were 14-20 years old (n=72 110). The remaining Swedish counties excluding bordering counties, without the policy change, were used as the control group (n=456 224). The outcomes of alcohol-related morbidity and mortality were collected from the Hospital Discharge Register and Cause of Death Register, in which average follow-up times were 38 years and 41 years, respectively. HRs with 95% CIs were obtained by Cox regression analysis.

RESULTS: In the fully adjusted model, no clear evidence of an association between increased alcohol availability during adolescence and alcohol-related morbidity (HR: 0.99, 95% CI 0.96 to 1.02) or mortality (HR: 1.02, 95% CI 0.95 to 1.10) was found.

CONCLUSION: The initial elevated risk of alcohol-related morbidity and mortality later in life among adolescents exposed to increased access to strong beer in Sweden vanished when a regional measure population density of locality was included in the model, which is important to consider in future research.

Published in General Health

BACKGROUND: Alcohol and in particular red wine have both immunomodulatory and neuroprotective properties, and may exert an effect on the disease course of multiple sclerosis (MS).

OBJECTIVE: To assess the association between alcohol and red wine consumption and MS course.

METHODS: MS patients enrolled in the Comprehensive Longitudinal Investigation of Multiple Sclerosis at the Brigham and Women's Hospital (CLIMB) who completed a self-administered questionnaire about their past year drinking habits at a single time point were included in the study. Alcohol and red wine consumption were measured as servings/week. The primary outcome was the Expanded Disability Status Scale (EDSS) at the time of the questionnaire. Secondary clinical outcomes were the Multiple Sclerosis Severity Score (MSSS) and number of relapses in the year before the questionnaire. Secondary MRI outcomes included brain parenchymal fraction and T2 hyperintense lesion volume (T2LV). Appropriate regression models were used to test the association of alcohol and red wine intake on clinical and MRI outcomes. All analyses were controlled for sex, age, body mass index, disease phenotype (relapsing vs. progressive), the proportion of time on disease modifying therapy during the previous year, smoking exposure, and disease duration. In the models for the MRI outcomes, analyses were also adjusted for acquisition protocol.

RESULTS: 923 patients (74% females, mean age 47 +/- 11 years, mean disease duration 14 +/- 9 years) were included in the analysis. Compared to abstainers, patients drinking more than 4 drinks per week had a higher likelihood of a lower EDSS score (OR, 0.41; p = 0.0001) and lower MSSS (mean difference, - 1.753; p = 0.002) at the time of the questionnaire. Similarly, patients drinking more than 3 glasses of red wine per week had greater odds of a lower EDSS (OR, 0.49; p = 0.0005) and lower MSSS (mean difference, - 0.705; p = 0.0007) compared to nondrinkers. However, a faster increase in T2LV was observed in patients consuming 1-3 glasses of red wine per week compared to nondrinkers.

CONCLUSIONS: Higher total alcohol and red wine intake were associated with a lower cross-sectional level of neurologic disability in MS patients but increased T2LV accumulation. Further studies should explore a potential cause-effect neuroprotective relationship, as well as the underlying biological mechanisms.

Published in General Health
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